Fitzgerald Stephen P, Bean Nigel G, Ruberu Ravi P
Department of General Medicine, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
The School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
J Comorb. 2017 May 10;7(1):50-63. doi: 10.15256/joc.2017.7.93. eCollection 2017.
The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study.
To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit.
We developed a method to calculate probabilistically the effect of all of a patient's comorbidities on their underlying utility, or well-being, at a future time point. From this, we derived a distribution of possible magnitudes of treatment benefit at that future time point. We then expressed this distribution as the probability of deriving at least a given magnitude of treatment benefit. To demonstrate the applicability of this method of decision analysis, we applied it to the treatment of hypercholesterolaemia in a geriatric population of 50 individuals. We highlighted the results of four of these individuals.
This method of analysis provided individualized quantifications of the effect of age and comorbidity on the probability of treatment benefit. The average probability of deriving a benefit, of at least 50% of the magnitude of benefit available to an individual without comorbidity, was only 0.8%.
The effects of age and comorbidity on the probability of deriving significant treatment benefits can be quantified for any individual. Even without consideration of other factors affecting external validity, these effects may be sufficient to guide decision-making.
在多种疾病并存的情况下，试验和指南的外部有效性或可推广性被认为较差。多种疾病并存如何影响特定治疗的获益程度，进而影响外部有效性，这方面的研究很少。
提供一种决策分析方法，以量化年龄和合并症对获得特定治疗获益程度概率的影响。
我们开发了一种方法，用于概率性计算患者所有合并症对其未来某个时间点潜在效用或幸福感的影响。据此，我们得出该未来时间点治疗获益可能程度的分布。然后，我们将此分布表示为获得至少特定治疗获益程度的概率。为证明这种决策分析方法的适用性，我们将其应用于50名老年人群的高胆固醇血症治疗。我们突出了其中4人的结果。
这种分析方法提供了年龄和合并症对治疗获益概率影响的个体化量化。获得至少相当于无合并症个体可获得获益程度50%的获益概率平均仅为0.8%。
年龄和合并症对获得显著治疗获益概率的影响可为任何个体进行量化。即使不考虑影响外部有效性的其他因素，这些影响可能足以指导决策。
